Provider Demographics
NPI:1275204794
Name:ALLEN, GWENDOLYN OLIVIA (CRNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:OLIVIA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10672
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0672
Mailing Address - Country:US
Mailing Address - Phone:205-532-6190
Mailing Address - Fax:
Practice Address - Street 1:1713 6TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0018
Practice Address - Country:US
Practice Address - Phone:205-975-4532
Practice Address - Fax:205-975-2969
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-063494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner